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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Dc — O67 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:, Assign To: J P 55 Date: yl(g/Zip, <br /> Intake Comments: Intake Commen s: <br /> Zone (1,-- <br /> ❑Make this a"W"Permit 0 SRC Required (Pre-Inup) Overlay/Agreement .N/A <br /> BIdgITI/ ilRem Size .3CsO Nonresidential Use )J/A <br /> Gara e Accessory Struct. Size (p(pV Residential Use cj F P. <br /> Number of Stories I + FAic►d100-1-- Proposed No.of Dwelling Units: <br /> Basement ❑No jYes Fin nfin Total No.of Dwelling Units: <br /> Type of Construction PlanninglLandscape Inspection Required before Final? ❑Yes giNo <br /> Occupancy Group I R G "In Lieu"Fee:Type: Amount$ U <br /> Occupancy Load / \ School Impact Fee: Total $ 0 <br /> Cert. of Occpuancy Required? I4No ❑Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 212018 02015 ❑Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing❑New System 56t Req'd Park Impact Fees for permits applied for after 1/1/2022: <br /> • Reason Sprinklers Required: Park Impact Fee Total$ 0 (net due after credit for existing uses) <br /> Fire Alarm: ❑Update Existing❑New System IgNot Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ®No <br /> Add!RCW.64.55 docs required prior to final? Dyes @No Additional Notes: <br /> VALUATION CALCULATION: Total$ )B)500 — <br /> j <br /> Approved By: vy' Date:Oil 8/Z ti <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments <br /> Additional Notes: -1-70A.Irij i . <br /> Approved By: .79/4f-- Date: _.y/3/2-e-/ ;d) <br /> FIRE DEPARTMENT' (A Bc)3('00 ' d: <br /> Separate/Deferred Submittals Required: <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: /-� r f c.)-°✓ �' <br /> Additional Notes: 0 This Perri <br /> ��i�.� <br /> ❑See PW F ,Q it). <br /> Fire Dept.Fees: ❑A Separat Per <br /> (❑ Review of As-Built Plans-NO FIRE FEE AND Elis ft ElMinimal or No Fire Scope-NO FIRE FEE ❑ Is is <br /> ❑ Review/inspection Scope-ADD FIRE FEE r❑ Is ir....--r..,u..... cell FUiuer gain with this folderfor permit Issuance) <br /> 1__I <br /> Approved By: Date: Will be issued separately(Separate Green Folder,PW issued ahead of Dfrnblic Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING Additional Notes: <br /> • <br /> Additional Notes: _ <br /> Approved By: Date: Completed B — Date: OZ/Z 4.-/d v 4 <br />